First ‘Bathtub’ dialysis catheter procedure at MidCentral Health

16/03/2011 | Dialysis Catheter Procedure

Palmerston North Hospital performed its first presternal (or “Bathtub”) peritoneal dialysis catheter operation on a patient last month.

The patient received the catheter after opting for peritoneal dialysis during the education and assessment phase that all potential dialysis patients go through.  Doctors initially looked at inserting the usual abdominal catheter so that the patient would be able to self care at home and maintain an independent lifestyle – the aim for all renal dialysis patients coming to MidCentral Health.

However, as the patient was larger and unsuitable for the normal length catheter which would have been too short to be effective, or be seen by the patient, renal staff researched what other options were available. They found that a longer presternal PD catheter, available in New Zealand, would be ideal for the patient.

Overseas research showed peritonitis infection rates were lower in patients with presternal catheters, compared to abdominal catheters; and the presternal catheters would still last as long and be as effective as abdominal catheters.
A benefit of the presternal catheter was that the position of the exit site being higher would be above the level of water in a bath, hence the name “Bathtub”, and could allow the patient to have a bath instead of showers as for other catheter patients. 

Being able to see the catheter because of its location on a bigger patient is another advantage for using presternal catheters. It allows the patient to care for the exit site to prevent infection and allow easy access to perform the dialysis treatment. This is usually a simple process for smaller patients who have the normal abdominal catheter inserted and the exit site is near the “tummy button”.

The surgeon worked with renal staff, and the first presternal catheter was successfully inserted in the patient a few weeks ago by MidCentral Health. Other renal units around the country have been using these catheters for larger patients with positive results, so this patient should be able to maintain a healthy and independent lifestyle as treatment allows.

Most abdominal catheters are inserted in theatre under local anaesthetic as a day case negating the need for an overnight stay, however the presternal catheter was inserted under general anaesthetic. The catheter is in two parts; one half is implanted into the abdominal cavity, and the other half is tunnelled under the chest wall and down through the waist area to join with the abdominal half. The extra length of the catheter that is tunnelled under the skin is better performed under general anaesthetic for the patient’s comfort.

Renal unit nurse manager Gillian Treloar said the successful operation was a reflection of the good relationship between the renal unit and surgical services, and in this case had produced an excellent outcome for the patient and groundbreaking technology for MidCentral Health.

“We encourage self care and look at the best treatment for the patient. This has had improved outcomes by matching the need of the patient to the service we are able to provide.

“The patient is doing well, but hasn’t started peritoneal dialysis yet – because of the usual three-week healing period after the procedure, before starting – but it will be soon.”

MidCentral Health renal staff feel that with the steady increase in demand for renal replacement therapies, and with many patients being larger people, that this new procedure could also be used successfully for other patients.

Contact: Communications Unit (06) 350-8945